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Recent Changes to the PEHP Preferred Drug List

The Preferred Drug List includes prescription medications that have been chosen by PEHP's Pharmacy and Therapeutics Committee—a team of local physicians, nurses, and pharmacists—to be available at a lower Copayment. The committee chooses medications that provide the best value based on quality, safety, effectiveness and cost. The Preferred Drug List is modified periodically with changes based on recommendations from the committee.

Below are the most recent updates to the Preferred Drug List.

DRUG NAME EFFECTIVE DATE ACTION COVERAGE PREFERRED DRUG LIST RECOMMENDATIONS
SIMPONI* 6/1/2009 ADDITION TIER 4  
NAMENDA* 6/15/2009 ADDITION TIER 2  
PRISTIQ* 6/15/2009 ADDITION TIER 2  
RETIN-A MICRO* 7/1/2009 DELETION TIER 3 TRETINOIN
AVANDIA 7/1/2009 DELETION TIER 3 ACTOS
AVANDARYL 7/1/2009 DELETION TIER 3 DUETACT
AVANDAMET 7/1/2009 DELETION TIER 3 ACTOPLUS MET
PROTOPIC 7/1/2009 DELETION TIER 3 ELIDEL
FROVA 7/1/2009 DELETION TIER 3 SUMITRIPTAN, MAXALT, RELPAX
AMERGE 7/1/2009 DELETION TIER 3 SUMITRIPTAN, MAXALT, RELPAX
ZOMIG 7/1/2009 DELETION TIER 3 SUMITRIPTAN, MAXALT, RELPAX
NASACORT* 7/1/2009 DELETION TIER 3 FLUTICASONE, FLUNISOLIDE, NASONEX
RHINOCORT* 7/1/2009 DELETION TIER 3 FLUTICASONE, FLUNISOLIDE, NASONEX
VERAMYST* 7/1/2009 DELETION TIER 3 FLUTICASONE, FLUNISOLIDE, NASONEX
NUTROPIN* 7/1/2009 DELETION TIER 4 HUMATROPE, GENOTROPIN, NORDITROPIN
TEV-TROPIN* 7/1/2009 DELETION TIER 4 HUMATROPE, GENOTROPIN, NORDITROPIN
OMNITROPE* 7/1/2009 DELETION TIER 4 HUMATROPE, GENOTROPIN, NORDITROPIN
SAIZEN* 7/1/2009 DELETION TIER 4 HUMATROPE, GENOTROPIN, NORDITROPIN
SEROSTIM* 7/1/2009 DELETION TIER 4 HUMATROPE, GENOTROPIN, NORDITROPIN
CELLCEPT 7/1/2009 DELETION TIER 3 MYCOPHENOLATE
SAVELLA 7/15/2009 ADDITION TIER 3 LYRICA
BYSTOLIC 7/15/2009 ADDITION TIER 3 ATENOLOL, METOPROLOL
TEGRETOL XR 8/1/2009 DELETION TIER 3 CARBAMAZEPINE XR
EXFORGE HCT 8/1/2009 ADDITION TIER 3 HYDROCHLOROTHIAZIDE, AMLODIPINE, BENICAR
TRILIPIX 8/1/2009 ADDITION TIER 3 FENOFIBRATE
RYZOLT ER 8/1/2009 ADDITION TIER 3 TRAMADOL
MOXATAG ER 8/15/2009 DELETION NO COVERAGE AMOXICILLIN
VIMPAT 8/15/2009 ADDITION TIER 3 ZONISAMIDE, TOPIRAMATE, LAMOTRIGINE
URSO, URSO FORTE 9/1/2009 DELETION TIER 3 URSODIOL
LAMICTAL ODT 9/1/2009 ADDITION TIER 3 LAMOTRIGINE
EFFIENT 9/1/2009 ADDITION TIER 3 PLAVIX
ADCIRCA* 9/15/2009 ADDITION TIER 4  
TUSSIONEX 10/1/2009 DELETION TIER 3 HYDROCODONE WITH HOMATROPINE
ALTACE 10/1/2009 DELETION TIER 3 RAMIPRIL
TOPROL XL 10/1/2009 DELETION TIER 3 METOPROLOL XL
MONOKET 10/1/2009 DELETION TIER 3 ISOSORBIDE
IMDUR 10/1/2009 DELETION TIER 3 ISOSORBIDE
BENZACLIN CARE KIT 10/1/2009 DELETION TIER 3 BENZACLIN GEL
PLAN B 10/22/2009 DELETION TIER 3 NEXT CHOICE
ONGLYZA 11/1/2009 ADDITION TIER 3 JANUVIA
CATAPRESS-TTS 11/1/2009 DELETION TIER 3 CLONIDINE PATCH
STARLIX 11/1/2009 DELETION TIER 3 NATEGLINIDE
ONSOLIS* 12/1/2009 ADDITION TIER 3 FENTANYL CITRATE
SEROQUEL XR 12/1/2009 ADDITION TIER 2  
ACEON 1/1/2010 DELETION TIER 3 BENAZEPRIL, ENALAPRIL, FOSINOPIRL, LISINOPRIL, RAMIPRIL
ZETIA* 1/1/2010 DELETION TIER 3 CRESTOR, LIPITOR, VYTORIN, NIASPAN, FENOFIBRATE
FORSENOL 1/1/2010 DELETION TIER 3 PHOSLO, RENVELA
PENTASA 1/1/2010 DELETION TIER 3 ASACOL, BALSALAZIDE, COLAZOL, SULFASALAZINE
CELEBREX 1/1/2010 DELETION TIER 3 IBUPROFEN, NAPROXEN, MELOXICAM
COREG CR 1/1/2010 DELETION TIER 3 CARVEDILOL
BONIVA 1/1/2010 DELETION TIER 3 ACTONEL, ALENDRONATE
XOPENEX HFA 1/1/2010 DELETION TIER 3  PROAIR HFA
DUAC 1/1/2010 DELETION TIER 3 BENZACLIN GEL, CLINDAMYCIN/BENZOYL PEROXIDE
RESTASIS 1/1/2010 DELETION TIER 3 GENTEAL (OTC), SYSTANE (OTC), ENDURA (OTC), REFRESH (OTC), CELLUVISC (OTC)
LACRISERT 1/1/2010 DELETION TIER 3 GENTEAL (OTC), SYSTANE (OTC), ENDURA (OTC), REFRESH (OTC), CELLUVISC (OTC)
EXELON PATCH 1/1/2010 DELETION TIER 3 EXELON CAPSULE, ARICEPT
ZYMAR 1/1/2010 DELETION TIER 3 VIGAMOX
SAPHRIS 1/15/2010 ADDITION TIER 3 SEROQUEL, XR, ZYPREXA, RISPERIDONE, GEODON

* May require prior authorization.

Members should always consult with their provider before making any changes to their drug treatment plan.

Preferred Drug List Definitions:
Tier 1: Preferred generic medications that are available at the lowest copayment
Tier 2: Preferred brand name medications that are available at a median copayment
Tier 3: Non-preferred medications that are available at the highest copayment
Tier 4: Specialty and injectible drugs at the benefit described in your benefit summary
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